I've been having some symptoms and wondered if anyone had any thoughts...

In chronological order:
Age 14, 2x tonsillectomies, haemoraged after op. Also had mild head ijury a year before.
Age 16, hypothyroid, and meniere's disease diagnosed. Thyroid left untreated (due to my not attending the Doctors appointment and going off the rails alittle )
Throughout 20s I think the hypothyroid symptoms became less and less. My periods used to be heavy where as now they are normal and I have no PMS at all.
I am always cold, and I have quite a poor appetite, I do however eat a healthy diet and have maintained a 'normal' body weight despite some fluctuations.

I started TTC at the beginning of 2012 and had a miscarriage at 8 weeks at the end of april.
Throughout the pregnancy I had an amazing appetite - I was able to enjoy eating 3 meals per day!
However, I was incredibly cold, I couldn't get warm, and I was very very constipated. It felt like everything in my body just slowed down. I also had permanent breast tenderness (which I have read can be a sign of low progesterone).

Prior to TTC I charted my BBT and found I had short luteal phase, something indicative of low progesterone.

I have been reading around and have found that progesterone enhances the expression of Thyroid hormone receptors in cells walls, and thus low prog. can lead to the thyroid hormones not being able to get into cells, despite normally circulating thyroid levels.
Also, progesterone seems to affect the hypothalamus, by changing the 'set pint' body temp to be raised, thus telling the pituitary to release more TSH to raise body temp.

I charted my BBT this month, I have remained exhausted since the miscarriage and have been pretty much unable to do anything even my job . Interestingly though, my energy levels seemed to increase pretty much i time with the thermal rise indicating more progesterone, at the end of the month. My BBT temps are high enough (above 36 C) However during the day I drop to really cold 34.8 - 35.2. My blood pressure is typically 90 over 45.

Sp I am wondering, is my thryoid dysfunctional, and/or progesterone? and If so why? Any thoughts?

Had some bloods done on last day of luteal phase:
TSH was 0.52 (normal=0.5 - 5.0), indicates that either my thyroid hormones are high (which would be normal after a pregnancy) or that my hypothalamus or pituitary are not producing enough TSH for some other reason.
LH 10.3iu/L (1 - 11.4)
FSH 4.7iu/L (1.7 - 7.7) I've read that LH:FSH ratio should be 1:1
Prolactin 329 miu/L (102 - 496)
Estrogen 125 pmol/L (147 - 958) Low, but this was last day of luteal phase and the range for follicular is 90 - 716.
SHBG 109.3nmol/L (25 - 122)
Androgen 0.5 (0.3 - 5.6)
Testosterone 0.5nmol/L (0.3 - 1.7)

Hi- Heartfish. I am a TTC/ infertility veteran. I have lots to share with you and will post back in a little while. Just wanted to let you know someone will be answering your question (though not sure how much help I will be, sounds as though you know your stuff). I do have some medical websites I can share with you but I am unable to post them here due to forum rules.
Are you currently taking any thyroid medication? Any thyroid labs to share?

I am going to have to write to you in increments because there is too much to cover in one message.
HCG (pregnancy hormone) is structurally similar to TSH, so the fact that your appetite improved during pregnancy doesn't surprise me. The HCG may have given your thyroid the stimulation that your pituitary is not. During pregnancy, this often leads to a suppressed TSH in women with healthy thyroids, more so in the middle of the first trimester, when HCG levels are at their peak. I also had an amazing (too amazing) appetite during pregnancy, though not the amazing metabolism to go with it ;-)

LH and FSH should be similar but I think this only applies to Day 3 lab work. You should really have those re-measured on cycle day 2 or 3 for an accurate picture. Also, estradiol should be measured on day 3 too. It would be helpful to get a mid-luteal progesterone level (first thing in the morning, before eating). When you have your TSH measured again, also have them check FREE T4 and FREE T3 and it wouldn't hurt to check for thyroid antibodies, even though your low TSH could indicate a pituitary/ hypothalamic issue.

My BBT is almost identical to yours (97 deg F low in follicular phase and 98.2 luteal temps). Actually, sometimes it gets up to 98.4. My LP has been as short as 10 days on some charts and up to 13 days. However, my first month on desiccated thyroid gave me a 14 day LP. Waiting to see what this month will do, 13 dpo so far.

Honestly, your chart doesn't look bad. Seems like you have a decent LP (14 days?) and you are not ovulating too early or too late. Your high temp could use a little bump. You could try using a progesterone cream. I have used Emerita brand and liked it, though I decided to try addressing the cause of my low progesterone rather than using progesterone supplements because I was afraid the low progesterone was a symptom, not a cause. Are you using B Complex? After I started using B Complex 50 mg, my progesterone levels almost tripled (to optimal levels). Not sure what it is like these days, since starting thyroid replacement.

It has been speculated that progesterone is a necessary component of thyroperoxidase, which is a precursor to thyroid hormone. However, low thyroid hormone throws off the hypothalamic-pituitay-ovarian axis and causes imbalances in estrogen/ progesterone, so it's a vicious cycle. By the way, it's progesterone's stimulatory effect on the thyroid that causes the temperature shift in the luteal phase (and in pregnancy).

Have you had your ferritin checked? This could be another cause of your coldness and lowish temps. Low ferritin also aggravates hypothyroidism.

Your SHBG looks high. You're using different units than I do, so it doesn't mean a whole lot before I convert it. Because it's on the high side and your androgens are on the low side, your FAI (free androgen index) and free testosterone would be extremely low, which could also cause symptoms.

Have you had your ovaries examined on ultrasound to see if they appear polycystic? I'm sure you've been wondering about PCOS with your elevated LH/FSH ratio but getting a day 3 result would be more meaningful.

I'm sure I'll think of more later.

Last edited by bee01; 06-22-2012 at 08:30 AM.

The Following User Says Thank You to bee01 For This Useful Post:heartfish (06-22-2012)

Hi
Thank you so much for this info!
Unfortunately it is unlikely that I will be able to get any of these checked again, I'm in the UK and persuading my GP to do these tests has taken several visits!
Today I had progesterone, blood count and CRP tested, results should be back next week.
It's interesting that a B complex tripled your progesterone - did you think your diet provided sufficient B vitamins prior to taking the supplement, or did you think it may be low?
I feel that my diet should be adequate in B vitamins, but I will try a B complex and see what happens with my chart.

I have not had an ultrasound to check for PCOS, however - the last 2.5 years I have had thick dark hairs on my chin. Doc says it's because I'm now 31! I disagree, but my male hormones seem normal. Wondered if it could be due to stress, the last 3 years have had extremely stressful periods in them.

SHBG is low in PCOS (insulin resistance) however a high SHBG and normal/low testosterone and estrogen could indicate that there is little of these hormones actually circulating.
So I feel like this indicates I don't have PCOS, but the high SHBG is indicating...something?

I also have high SHBG with normal testosterone. It works out to a low FAI/ free testosterone. I too have the pesky hair growth but it has been an issue for me since my late teens (I'm 32). My RE says that circulating levels of androgens do not necessarily reflect what is happening at the cellular level. Also, women with mediterranean roots are more testosterone sensitive than women of Asian heritage, for example. It's why middle Eastern and Mediterranean women are hairier than average.

Insulin Resistance is a tough one to prove. Not everyone with IR will have high fasting glucose and insulin levels. Usually a glucose tolerance and insulin test will reveal abnormal responses to glucose. Having your hba1c tested might be helpful too, as it will reveal what your average glucose readings from the past 3 months are.

My ovaries appear polycystic and my LH is 50% higher than my FSH (usually, PCOS women have LH that is 2 to 3 times higher than FSH) but my periods are pretty regular, if not a little short and I always ovulate, so it's hard to pinpoint the exact cause. It's one of those annoying, idiopathic things that sometimes requires steamrolling over your natural hormonal responses with fertility medications.

I hope this is not too raw for you to discuss yet but did they discover a cause for your miscarriage. Most miscarriages at that stage are caused by chromosomal issues with the embryo but I wouldn't take that as gospel, especially if your progesterone and thyroid issues are iffy. Are you testing for CRP because you suspect endometriosis? I have never had that test done (one of the few!).

Also good to test would be homocysteine levels. High levels could mean you are not absorbing folic acid as is the case with MTHFR gene mutations.

If you want that bloodwork done, you might have to go private, or have the testing done through an internet testing lab.

What area are you in? I can send you a list of top recommended thyroid doctors.

Hmmm that is the problems with some of these tests, who knows what is happening at a cellular level.
No the GP says the same old story of mc very common, etc, and need to have 3 before investigations.
I feel that my body temperature was a big indication that something was not right.

I'm in Devon. I would be really interested to find out about getting some tests done privately.

Thank you so much for this info. It is really nice to speak with someone who is interested in this too!

Hmmm that is the problems with some of these tests, who knows what is happening at a cellular level.
No the GP says the same old story of mc very common, etc, and need to have 3 before investigations.
I feel that my body temperature was a big indication that something was not right.

I'm in Devon. I would be really interested to find out about getting some tests done privately.

Thank you so much for this info. It is really nice to speak with someone who is interested in this too!

Heartfish- did you miscarry naturally or did you have to have a D & C? Do you know at what point the pregnancy ended (did you have a dating ultrasound?) Was your progesterone tested at any point in the pregnancy? Did your temperatures ever increase from your regular luteal temps? I would suggest using a free online BBT charter, if you aren't already.
I have a few articles that I can send you but I cannot post them on here due to forum rules.

Hi, not got much tiime so can only briefly reply just now.
I would love to read the article, can you pm them me?

I didn't take my temp at any time during pregnancy, it just didn't occur to me! I never had a scan or progesterone tested. miscarried naturally, everything came out so I didn't need a D&C. From what I saw, I would say he sac size and the size of th baby/fetus was 8 weeks.

Hi Heartfish, I've been on desiccated thyroid for a little over two months now (I have low FT3) and both months resulted in a 14 day LP for the first time ever (other than during clomid or progesterone supplementation cycles). I'm thinking my fertility problems are being caused by hypothyroidism... we'll see!

Hmm, I am thinking of paying for a private FT3 and FT4 test.
I just got my results back from the test i had last week, it was done day 29 of a 30 day cycle.
CRP was 'less than 1mg' 'repeat test required' - don't know why i need to repeat this test?!
Blood Count was 'normal' but don't have the figures - receptionist said it was too many to read out.
Progesterone was 14nmol/L
I'm struggling to find a reference range for end of luteal as most are performed mid luteal.
It's irritating because I thought that it should be done on day 21 but the doctors get irritated if you tell them how to do their job. Anyway, I think they may need to repeat on day 21.